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Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study Economic and Quality-of-Life Outcomes of Natriuretic Peptide–Guided Therapy for Heart Failure Intravascular ultrasound predictors for edge restenosis after newer generation drug-eluting stent implantation Clinical impact of intravascular ultrasound-guided chronic total occlusion intervention with zotarolimus-eluting versus biolimus-eluting stent implantation: randomized study Fractional flow reserve derived from CCTA may have a prognostic role in myocardial bridging IVUS Guidance for Coronary Revascularization: When to Start, When to Stop? Impact of intravascular ultrasound-guided percutaneous coronary intervention on long-term clinical outcomes in a real world population A Randomized Study of Distal Filter Protection Versus Conventional Treatment During Percutaneous Coronary Intervention in Patients With Attenuated Plaque Identified by Intravascular Ultrasound The Future of Biomarker-Guided Therapy for Heart Failure After the Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) Study Temporal Trends in Inpatient Use of Intravascular Imaging Among Patients Undergoing Percutaneous Coronary Intervention in the United States
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Letter2015 Oct;8(10):1228-9.

JOURNAL：JACC Cardiovasc Imaging. Article Link

Superficial Calcium Fracture After PCI as Assessed by OCT

Kubo T, Shimamura K, Ino Y et al. Keywords: calcium fracture; stent underexpansion; OCT

ABSTRACT

Heavily calcified lesions in coronary arteries have been known to cause stent underexpansion, which increases the risk of in-stent restenosis. Plaque modification before stent implantation is considered to be the key for treatment of calcified lesions. We hypothesized that calcium fracture by percutaneous coronary intervention (PCI) might be associated with adequate stent expansion and favorable late outcome.


From the coronary catheterization registry of Wakayama Medical University between February 1, 2010 and August 31, 2013, we retrospectively selected 61 patients with chronic stable angina who had a heavily calcified culprit lesion on coronary angiography. The heavily calcified lesion on coronary angiography was identified by radiopacities noted without cardiac motion before contrast injection, generally compromising both sides of the arterial lumen. Everolimus-eluting stent was used for PCI. PCI procedures including stent size, pre- and post-dilation, and inflation pressure were determined by each physician. Optical coherence tomography (OCT) was performed before and immediately after PCI. Maximal calcium thickness, maximal calcium arc, and maximal calcium length were measured on each candidate frame selected by visual screening in the OCT images before PCI. Calcium fracture and stent expansion were assessed in the OCT images immediately after PCI. Calcium fracture was characterized by a gap of calcium and direct exposure of calcium to the lumen at the gap. The calcium fracture thickness was measured at the edge of the fracture. The minimal stent area was measured on a candidate frame selected by visual screening. Stent expansion index was calculated as the minimal stent area divided by the average of the proximal and distal reference lumen area. Scheduled follow-up angiography was conducted 10 months after PCI.
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